Abstract 1754
Purpose: To evaluate how the demographic and health care practices have changed for neonates reported to the Extracorporeal Life Support Organization (ELSO) registry from 1/1/1988-1/1/1998. Methods: Data from the ELSO registry was used to evaluate the changes in demographics, use of alternate therapies before ECMO, severity of illness, duration of ECMO therapy and mortality over a 10 yr period. All data on neonates reported between 1/1/88 and 1/1/98 was used. Verification checks were done on all fields to eliminate nonsense outliers. We separated the neonates into two group; those with and those without a congenial diaphragmatic hernia (CDH). All analyses were done on the total group and each subgroup separately. Changes in continuous data were analyzed by year using ANOVA. Year differences in categorical data were evaluated with Chi-square analysis. We also used Linear Trend Test and Cochran-Armitage Trend Test to evaluate time related changes. Results: Data on 12,175 neonates was studied. Over the decade, there were no changes in mean gestational age, percent male, age ECMO started, pH or PaCO2 just before ECMO. The proportion of neonates with CDH increased from 18 to 26%, while the proportion with RDS decreased from 15 to 4%. Other diagnostic categories remained constant. The use of surfactant, high frequency ventilation, and inhaled nitric oxide increased from 0% in 1988 to 36, 46, and 24% respectively in 1997. The mean peak pressure being used just before ECMO decreased (47±10 in 1988 to 39±12 in 1997) and the mean PaO2/FiO2 ratio increased (38±23 in 1998 to 48±36 in 1997). The primary mode of ECMO remains venoarterial. However, the use of venovenous ECMO increased from 1 to 32% over the decade. Duration of ECMO treatment increased overall and this trend was seen for both patients with and without CDH (124±67 to 141±104 hours for the non-CDH group; 161±99 to 238±141 hours for the CDH group). The number of centers reporting data to the ELSO registry increased from 52 in 1988 to a peak of 100 in 1993. In 1997, 96 centers reported data to the ELSO. The average number of patients reported from each site decreased from a peak of 18 in 1991 to 9 in 1997. Mortality increased from 18-22%. However, when corrected for the relative increase in neonates with CDH, this trend disappeared. Diagnostic-specific mortality rates remained constant. The occurrence of intracranial hemorrhage and/or infarct also stayed constant at 16%. Univariate and multivariate analysis showed no association between surfactant, HFV or iNO use before ECMO and mortality or brain injury on ECMO. Conclusions: The population of neonates treated with ECMO in 1997 was very different from patients treated in the 80's and early 90's. They were exposed to several new therapies, appear to be less ill and were cared for at centers that reported fewer cases per year.
